| NPI | 1093213126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL 20155) |
| Additional Taxonomies | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: FL SI3470) |
| 235Z00000X Speech-Language Pathologist, (Licence: FL 10154) | |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2022-08-04 |