| NPI | 1518371962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: TX 115984) |
| Additional Taxonomies | 2355S0801X Specialist/Technologist Speech-Language Assistant (Licence: TX 37381) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2022-07-20 |