| NPI | 1841750064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CO SLP.0005212) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2025-03-18 |