| 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 |