| NPI | 1780165787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 171M00000X Case Manager/Care Coordinator | |
| 101YM0800X Counselor, Mental Health (Licence: CA 96110) | |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2026-07-29 |