| NPI | 1235580119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: WA BA60781563) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CL60621291) |
| 103K00000X Behavior Analyst (Licence: 1-17-26402) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2018-01-03 |