| NPI | 1245738079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 30003672) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA18656) |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2025-09-29 |