| NPI | 1780144501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker | |
| 175T00000X Peer Specialist | |
| 175T00000X Peer Specialist (Licence: CA MPSS-XRYJKD) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-01-30 |