| NPI | 1487313433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 15555) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: LA 8442) |
| Enumeration Date | 2021-12-16 |
| Last Update Date | 2024-09-27 |