| NPI | 1407273295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IN 22004495A) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 103445) |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2018-08-22 |