| NPI | 1497376578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PA PC005624) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 103TF0000X Psychologist Family | |
| 103TS0200X Psychologist School | |
| 106S00000X Behavior Technician | |
| 225100000X Physical Therapist | |
| 225XP0200X Occupational Therapist Pediatrics | |
| 235Z00000X Speech-Language Pathologist | |
| 3747P1801X Technician Personal Care Attendant | |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2020-04-30 |