| 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 |