| NPI | 1619499837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 115183) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WI 4489-154) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2019-03-05 |