| NPI | 1124541792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: PA SL011571) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NC 11096) |
| 235Z00000X Speech-Language Pathologist, (Licence: FL SA12982) | |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2023-10-30 |