| NPI | 1093332611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2355S0801X Specialist/Technologist, Speech-Language Assistant |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 222Q00000X Developmental Therapist | |
| 252Y00000X Early Intervention Provider Agency | |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2022-05-16 |