| NPI | 1518432129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MN 9845) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WY SP-982) |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2018-10-10 |