| NPI | 1225689839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ9312) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CO SLP.0005488) |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2023-07-05 |