| NPI | 1760207955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor | |
| 172V00000X Community Health Worker | |
| 372600000X Adult Companion | |
| Enumeration Date | 2024-11-21 |
| Last Update Date | 2025-07-09 |