| NPI | 1104220987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WA LH60526071) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2024-07-10 |