| NPI | 1497380406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 171M00000X Case Manager/Care Coordinator | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA E1055877) | |
| 101YM0800X Counselor, Mental Health (Licence: CA E1055877) | |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2026-08-10 |