| NPI | 1184049629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: WA SP60405596) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WA CG60424975) |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2014-02-20 |