| NPI | 1609575356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ13218) |
| Additional Taxonomies | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: FL SI7260) |
| 106S00000X Behavior Technician (Licence: FL RBT-23-259028) | |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2026-02-25 |