| NPI | 1730762477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61282676) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2022-08-03 |