| NPI | 1306248315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: WA 106S00000X) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60152904) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2016-07-15 |