| NPI | 1083857478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA SI60042650) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AZ SLP15085) |
| 235Z00000X Speech-Language Pathologist, (Licence: OR 18088) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2025-10-14 |