| NPI | 1396113189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: PA SL012925) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: DE 01-0001495) |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2022-03-16 |