| NPI | 1336929611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA d3406721) |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2026-02-26 |