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 |