| NPI | 1215400676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: KY 2059) |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2019-05-22 |