| NPI | 1023325057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: ME SP2038) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2024-12-06 |