| NPI | 1598046658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ6190) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA14094) |
| 235Z00000X Speech-Language Pathologist, (Licence: TX 113725) | |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2022-12-03 |