| NPI | 1487176657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OR 016287) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 112945) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2022-07-21 |