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 |