NPI | 1043665011 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: CO 14113707) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: MI 14113707) |
Enumeration Date | 2016-04-27 |
Last Update Date | 2024-11-28 |