| NPI | 1821569963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: WA CG60525494) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA HP60781328) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO60917941) | |
| 101YM0800X Counselor, Mental Health (Licence: WA CG60525494) | |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2021-01-22 |