| NPI | 1861188054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-CPASBN) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA MPSS-CPASBN) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2024-01-04 |