| NPI | 1568166064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 123353) |
| Additional Taxonomies | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: TX 42904) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2025-01-14 |