| NPI | 1548820285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: UT 11331224-4102) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: UT 11331224-4104) |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2021-12-01 |