| NPI | 1225394851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA15053) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: ASHA 00393298) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2022-01-26 |