| NPI | 1275941171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 117533) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: LA 6424) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2023-05-01 |