| NPI | 1831307107 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA 1-06-3081) |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2021-04-19 |