| NPI | 1467009589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: SC 7553) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NC 13306) |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2024-12-16 |