| NPI | 1508182866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: MD 10010) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: AZ TSLP6273) |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2021-11-04 |