| NPI | 1861952004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61381149) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2023-08-22 |