| NPI | 1134839590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 10198) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA18137) |
| Enumeration Date | 2022-11-28 |
| Last Update Date | 2022-11-28 |