| NPI | 1811889454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-MYVXTO) |
| Enumeration Date | 2025-07-17 |
| Last Update Date | 2026-07-27 |