| NPI | 1477275394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CO 24458646) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 102424) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2024-08-16 |