| NPI | 1972925568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: WA 1-15-19009) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60242504) |
| 103K00000X Behavior Analyst (Licence: WA BA60791227) | |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2024-09-06 |