| NPI | 1831676196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH61086334) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2020-12-11 |