| NPI | 1518224369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA CG60410111) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: OR 103K00000X) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2014-05-14 |