| NPI | 1760056170 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2024-07-03 |