| NPI | 1639679111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 14356832) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2026-08-07 |