| NPI | 1649513383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 462354190) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 105956) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2023-05-23 |