| NPI | 1902104524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC005810) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: PA PC005810) |
| 103K00000X Behavior Analyst (Licence: PA BH000583) | |
| Enumeration Date | 2011-03-06 |
| Last Update Date | 2023-09-26 |