| NPI | 1093260481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: DE O1-0001676) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: GA SLP009365) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2019-06-14 |