| NPI | 1245709104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC011651) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA BH003330) |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2023-08-24 |