| NPI | 1225438195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC008936) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA BH002313) |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2022-04-14 |