| NPI | 1477208098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA BH005766) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA BH005766) |
| 101YP1600X Counselor, Pastoral (Licence: PA BH005766) | |
| 103K00000X Behavior Analyst (Licence: PA BH005766) | |
| Enumeration Date | 2022-02-14 |
| Last Update Date | 2022-02-14 |