| NPI | 1639820665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: CA 9038) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-21-184776) |
| 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: FL 5391) | |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2024-09-30 |