| NPI | 1104553650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NM SAH-2025-0068) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NM SLPA7463) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2026-01-15 |