| NPI | 1083209977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: ND 2440) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2023-06-26 |