| NPI | 1972451854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: 164x000000x) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 735367) |
| Enumeration Date | 2026-03-17 |
| Last Update Date | 2026-03-17 |