| NPI | 1457979965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA12193) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MI 7101000117) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2020-07-10 |