| NPI | 1043923519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NV SP-3551) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 36625) |
| Enumeration Date | 2022-12-29 |
| Last Update Date | 2024-04-30 |