| NPI | 1639827314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 101Y00000X Counselor |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2022-03-12 |
| Last Update Date | 2022-03-12 |