| NPI | 1700183944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-10-7243) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG 60190232) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2016-08-02 |