| NPI | 1578203709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MD 10342) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: DE O1-0012013) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2022-09-19 |