| NPI | 1063991081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60938424) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 027884-1) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2020-01-06 |