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 |