| NPI | 1053936005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA24400) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2026-03-02 |