| NPI | 1043513534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 051179) |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2025-11-19 |