| NPI | 1386016772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MD 08327) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 01195L) |
| 235Z00000X Speech-Language Pathologist, (Licence: CO SLP.0003345) | |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2018-09-05 |