| NPI | 1649134065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 101YM0800X Counselor, Mental Health | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2025-12-10 |
| Last Update Date | 2025-12-18 |