| NPI | 1588202337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL61018048) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AZ 016464) |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2019-12-11 |