| NPI | 1164138129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL61493069) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: KY 282032) |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2024-03-14 |