| NPI | 1063926632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ8338) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: GA SLP010868) |
| Enumeration Date | 2017-11-18 |
| Last Update Date | 2019-12-13 |