| NPI | 1417308479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH61516265) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103K00000X Behavior Analyst (Licence: WA CG60677601) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2024-02-19 |