| NPI | 1265116479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IA 126541) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AZ TSLP14473) |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2024-07-18 |