| NPI | 1427627454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: SC 8849) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2025-05-20 |