| NPI | 1417845884 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2025-06-25 |
| Last Update Date | 2026-03-18 |