| NPI | 1649671892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NM SLP4461) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NM 4461) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2019-07-10 |