| NPI | 1629813738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 372600000X Adult Companion |
| 373H00000X Day Training/Habilitation Specialist | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2024-06-29 |
| Last Update Date | 2025-05-08 |