| NPI | 1457785040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA13067) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ6296) |
| Enumeration Date | 2013-08-30 |
| Last Update Date | 2021-12-14 |