| NPI | 1407643869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC018358) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: UT 14271722-2506) |
| Enumeration Date | 2025-04-21 |
| Last Update Date | 2026-06-03 |