| NPI | 1609076603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2355S0801X Specialist/Technologist Speech-Language Assistant (Licence: TX 34069) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: TX 0-15-6734) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2016-04-28 |