| NPI | 1659169811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 42434) |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2026-06-11 |