| NPI | 1578283180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 172V00000X Community Health Worker (Licence: CA 10877) | |
| Enumeration Date | 2022-09-01 |
| Last Update Date | 2025-04-16 |