| NPI | 1104491125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA20348) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ10037) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2022-07-06 |