| NPI | 1669915682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA BH000677) |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2022-03-01 |