| NPI | 1497689913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MN 1002345) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MN LICC-4297) |
| Enumeration Date | 2026-06-10 |
| Last Update Date | 2026-06-10 |