| NPI | 1386882108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IL 146.009775) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 104807) |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2021-07-23 |