| NPI | 1174975890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MN 9702) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2024-05-01 |