| NPI | 1639669534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OK 4961) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: OK 1-23-67302) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2024-01-18 |