| NPI | 1063194918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 175T00000X Peer Specialist | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2023-08-01 |
| Last Update Date | 2025-07-08 |