| NPI | 1174238133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2023-01-13 |
| Last Update Date | 2025-09-19 |