| NPI | 1053806166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MN 10448) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IA 092255) |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2024-02-09 |