| NPI | 1609425420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61238290) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2025-08-04 |