| NPI | 1568906295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA SLP.LL.60731420) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AZ SLP10920) |
| 235Z00000X Speech-Language Pathologist, (Licence: CA 28065) | |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2022-03-23 |