| NPI | 1033825104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NM SAH-2024-0053) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MI 7101008817) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2024-09-12 |