| NPI | 1477140408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: AZ SLPA15318) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OK RBT-20-149067) |
| Enumeration Date | 2020-12-23 |
| Last Update Date | 2024-07-10 |