| NPI | 1770292831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist (Licence: CA B5209333) |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: CA NPPES) |
| Enumeration Date | 2022-11-17 |
| Last Update Date | 2026-01-27 |