NPI | 1124658356 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: WA MC61661558) |
Additional Taxonomies | 101Y00000X Counselor |
106S00000X Behavior Technician | |
Enumeration Date | 2020-01-15 |
Last Update Date | 2025-03-17 |