| NPI | 1548657125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: TX 112364) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: OK 4357) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2021-09-14 |