| NPI | 1124755954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61300145) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WA BA61252101) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2025-03-29 |