| NPI | 1649118092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-DJQEUP) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2026-03-24 |
| Last Update Date | 2026-08-25 |