| NPI | 1538902432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: 14443644) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NC 30003342) |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2024-09-11 |