| NPI | 1225912520 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist |
| Enumeration Date | 2025-08-01 |
| Last Update Date | 2025-08-01 |