| NPI | 1811291982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH 60495187) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WA 1-07-3686) |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2015-03-24 |