| NPI | 1255080396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ13150) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-20-121683) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2026-05-20 |