| NPI | 1881095370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60931367) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2020-03-09 |