| NPI | 1083196539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61588877) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2018-08-31 |
| Last Update Date | 2025-01-17 |