| NPI | 1659763282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 174400000X Specialist | |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2026-05-29 |