| NPI | 1629550959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IL 146.014791) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IL 242.004992) |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2020-08-04 |