| NPI | 1043093099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 30000844) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL018979) |
| 235Z00000X Speech-Language Pathologist, (Licence: TX 124682) | |
| Enumeration Date | 2023-08-15 |
| Last Update Date | 2026-07-29 |