| NPI | 1447714084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: FL SA21113) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: NJ 41YS01076900) |
| 235Z00000X Speech-Language Pathologist (Licence: PA SL015025) | |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2023-05-04 |