| NPI | 1336702869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: RI SP01756) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CO SLP.0003909) |
| 235Z00000X Speech-Language Pathologist, (Licence: WA LL60952352) | |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2023-03-08 |