| NPI | 1487082483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NV SP-1519) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA SP22375) |
| 235Z00000X Speech-Language Pathologist, (Licence: MN 10121) | |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2019-02-28 |