| NPI | 1902512965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-OFAEHW) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2025-07-23 |