| NPI | 1083199434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 106S00000X Behavior Technician | |
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2025-04-23 |