| NPI | 1699254128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| 101Y00000X Counselor | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2025-06-15 |