| NPI | 1669513586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 33379) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2025-05-09 |