| NPI | 1003629007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 103TF0000X Psychologist Family |
| 103TS0200X Psychologist School | |
| 1041C0700X Social Worker Clinical | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2025-01-31 |
| Last Update Date | 2025-07-29 |