| NPI | 1114221736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RI-R1307241622) |
| Enumeration Date | 2010-12-23 |
| Last Update Date | 2026-05-04 |