| NPI | 1952972069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-VURWPG) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101Y00000X Counselor | |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2024-12-22 |