| NPI | 1396391223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CO SLP.0004599) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AZ TSLP11814) |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2021-10-15 |