| 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 |