| NPI | 1578284105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OH SP.15462) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: OH COND.20222051-SP) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2023-07-12 |