| NPI | 1063073310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MA 77541) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2020-04-15 |