| NPI | 1194058628 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist | 
| Additional Taxonomies | 101Y00000X Counselor | 
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2009-09-16 | 
| Last Update Date | 2025-08-29 |