| NPI | 1093197022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA15234) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ7139) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2018-03-17 |