| NPI | 1558629642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: TX 111414) |
| Additional Taxonomies | 2355S0801X Specialist/Technologist Speech-Language Assistant (Licence: TX 35549) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2016-12-05 |