| NPI | 1366885816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: WA BA60767640) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CL60239428) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2023-02-07 |