| NPI | 1275767170 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC007713) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2024-05-30 |