| NPI | 1811527088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WI 6520) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WI RBT-19-101136) |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2024-07-08 |