| NPI | 1164846895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC-60926805) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2014-02-17 |
| Last Update Date | 2022-05-10 |