| NPI | 1588141188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: DE 0001680) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL014531) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2026-01-21 |