| NPI | 1336895713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC014826) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA BH004347) |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2022-09-15 |