| NPI | 1821986183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA MPSS-QINHEK) |
| Enumeration Date | 2025-06-25 |
| Last Update Date | 2025-07-24 |