| NPI | 1629407713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC 60403832) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WA CL60304328) |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2016-02-24 |