| NPI | 1316646367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 30003040) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 118926) |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2025-07-03 |