| NPI | 1558917666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WA RBT-19-95290) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2024-10-18 |