| NPI | 1952703738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CB60776212) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WA CG60499505) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2020-01-24 |