| NPI | 1619492337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA16552) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MI 7101005588) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2021-12-17 |