| NPI | 1699127969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA MC61303990) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WA CG60676407) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2023-06-29 |