| NPI | 1144795287 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist | 
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) | 
| Enumeration Date | 2018-10-04 | 
| Last Update Date | 2025-08-26 |