| NPI | 1326619453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ12513) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2025-08-06 |