| NPI | 1043689995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MI 7101007355) |
| Additional Taxonomies | 247200000X Technician, Other |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2021-08-31 |