| NPI | 1891545356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 175T00000X Peer Specialist (Licence: CA MPSS-UESHNA) | |
| Enumeration Date | 2024-03-26 |
| Last Update Date | 2025-11-18 |