| NPI | 1174985089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AL 3665) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA12185) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2019-09-26 |