| NPI | 1356469530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 30001523) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA8164) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2025-09-30 |