| NPI | 1841811379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61074273) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WA cg61074273) |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2020-08-11 |