| NPI | 1942769575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NM SLPA6942) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2019-10-10 |