| NPI | 1104658442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 172V00000X Community Health Worker | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2024-08-15 |
| Last Update Date | 2026-09-08 |