| NPI | 1275082802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: UT 10906563-4102) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA 14171) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2024-11-04 |