| NPI | 1174355150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA VN744125) |
| Enumeration Date | 2024-08-17 |
| Last Update Date | 2025-09-23 |