| NPI | 1104392638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: SZ3587) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2018-10-23 |