| NPI | 1023426962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 110054) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 38181) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2019-02-05 |