| NPI | 1619430493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NM 3285) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM 531) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2019-04-09 |