| NPI | 1184155939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: GA 6679) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: TN 7490) |
| 235Z00000X Speech-Language Pathologist (Licence: CO SLP.0003295) | |
| 235Z00000X Speech-Language Pathologist (Licence: FL SA16347) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2021-08-10 |