| NPI | 1790380277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA 000666) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA 1084097) |
| Enumeration Date | 2020-12-02 |
| Last Update Date | 2020-12-02 |