| NPI | 1588115414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA MC6114311) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2022-12-06 |