| NPI | 1780734459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist (Licence: CA 6020871735) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 6020871735) |
| 172V00000X Community Health Worker (Licence: CA 6020871735) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2025-06-03 |