| NPI | 1427684927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NM SLP6660) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2020-03-16 |
| Last Update Date | 2021-05-14 |