| NPI | 1255620290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-09-6411) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CL60134387) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2011-03-30 |