| NPI | 1083078893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60959426) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: OH COND 2016159) |
| 235Z00000X Speech-Language Pathologist, (Licence: SLP25171) | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2022-09-29 |