| NPI | 1689007288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: WA 1-11-8982) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CL60313566) |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2013-08-19 |