| NPI | 1407340755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: ND 1660) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MO 1660) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2023-02-10 |