| NPI | 1801439047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ10594) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-19-99714) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2022-05-12 |