| NPI | 1851109235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA Y8470003) |
| Additional Taxonomies | 372600000X Adult Companion |
| 372600000X Adult Companion | |
| Enumeration Date | 2024-12-18 |
| Last Update Date | 2026-01-05 |