| NPI | 1710859863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: FL SI8158) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: FL SI8158) |
| Enumeration Date | 2025-09-18 |
| Last Update Date | 2026-02-10 |