| NPI | 1932800653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 225400000X Rehabilitation Practitioner | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2026-01-20 |