| NPI | 1467108845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: ND 2222) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NV SP-730) |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2022-09-20 |