| NPI | 1871903658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC008141) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA BH001643) |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2015-05-01 |