| NPI | 1609340785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MS S4294) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 08376) |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2019-12-30 |