| NPI | 1033797741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ13366) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-20-128630) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2026-07-02 |