NPI | 1619177664 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: GA SLP004945) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: PA SL006227L) |
Enumeration Date | 2007-07-18 |
Last Update Date | 2022-09-29 |