| NPI | 1134788250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: TX 110936) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2021-12-02 |