| NPI | 1578037610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: 14134420) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: MD 08916) |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2019-01-11 |