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 |