| NPI | 1407334998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant |
| 225X00000X Occupational Therapist | |
| 2355S0801X Specialist/Technologist, Speech-Language Assistant | |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2018-08-06 |