| NPI | 1104593979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA20800) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ10409) |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2022-09-17 |