| NPI | 1558939751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MI 7107007852) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: OH SP.16725) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2026-05-07 |