| NPI | 1174219091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2025-04-07 |