| NPI | 1013164383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Q00000X Developmental Therapist |
| Additional Taxonomies | 101Y00000X Counselor |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2022-06-21 |