| NPI | 1487169694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 105298) |
| Additional Taxonomies | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: TX 40098) |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2023-05-01 |