| NPI | 1073903365 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MO 2016025316) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60532450) |
| 235Z00000X Speech-Language Pathologist, (Licence: TX 109995) | |
| 235Z00000X Speech-Language Pathologist, (Licence: KS 3973) | |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2020-04-27 |