| NPI | 1386092450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: UT 12178095-4102) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2022-05-24 |