| NPI | 1053962969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 372600000X Adult Companion |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 172V00000X Community Health Worker | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2025-05-12 |