| NPI | 1497337489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61647914) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: TX RBT-20-134369) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2025-01-30 |