| NPI | 1932590585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA LH 60189083) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WA FC 00000202) |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2015-02-17 |