| NPI | 1225654049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 30003412) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 39272) |
| 235Z00000X Speech-Language Pathologist, (Licence: DE O1-0001829) | |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2025-05-12 |