| NPI | 1518402668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: LA 4845) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MS S4255) |
| 235Z00000X Speech-Language Pathologist, (Licence: TX 113117) | |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2018-07-05 |