| NPI | 1881456812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist (Licence: CA 165798) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA 165798) |
| Enumeration Date | 2024-01-25 |
| Last Update Date | 2025-06-03 |