| NPI | 1649606153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: WA CG60415602) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60415602) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2013-09-17 |