| NPI | 1497320311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: AZ SLPA14013) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2022-08-01 |