| NPI | 1730512856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: CA 27201) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2020-02-27 |