| NPI | 1205230828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC007806) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA BH000550) |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2014-10-09 |