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 |