| NPI | 1568809960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NM SLP7382) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 07090) |
| 235Z00000X Speech-Language Pathologist, (Licence: IN 22007011A) | |
| 235Z00000X Speech-Language Pathologist, (Licence: LA 8200) | |
| Enumeration Date | 2013-05-27 |
| Last Update Date | 2021-06-29 |