| NPI | 1043633902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 34530) |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2025-03-24 |