| NPI | 1588216170 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist | 
| Additional Taxonomies | 101Y00000X Counselor | 
| 101Y00000X Counselor (Licence: 101Y00000X) | |
| 101Y00000X Counselor | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2019-07-12 | 
| Last Update Date | 2025-06-16 |