| NPI | 1053921858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: GA 009251) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: GA SLP009251) |
| Enumeration Date | 2020-08-06 |
| Last Update Date | 2021-03-03 |