| NPI | 1164181913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2021-12-09 |
| Last Update Date | 2025-05-09 |