| NPI | 1326501388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 372600000X Adult Companion | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2026-05-08 |