| NPI | 1902490212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA BH00297) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA BH00297) |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2021-02-26 |