| NPI | 1457739963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 030963) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: GA PCET002167) |
| 235Z00000X Speech-Language Pathologist, (Licence: GA SLP009177) | |
| Enumeration Date | 2015-05-16 |
| Last Update Date | 2021-10-01 |