| NPI | 1205130242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 113349) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IL 146010063) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2022-03-24 |