| NPI | 1861092033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-HOVMZT) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2024-07-18 |