| NPI | 1356107049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: MA SPA100358) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-09-06 |