| NPI | 1174095343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MD 11743) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA 7343917) |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2025-09-25 |