| NPI | 1013876655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 30004667) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 11298) |
| 235Z00000X Speech-Language Pathologist, (Licence: MD 02831L) | |
| Enumeration Date | 2026-01-20 |
| Last Update Date | 2026-04-21 |