| NPI | 1376660282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist (Licence: WA LF60086700) | |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2024-09-21 |