| NPI | 1124785746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: ME SP4382) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IA 11617) |
| 235Z00000X Speech-Language Pathologist, (Licence: MN 10588) | |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2025-08-06 |