| NPI | 1427594159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: FL SI6238) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2025-12-15 |