| NPI | 1548743925 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 111967) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MI 7101007562) |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2024-06-03 |