| NPI | 1851018162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 101YM0800X) |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2026-04-06 |