| NPI | 1649815531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OH SP.14722) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: OH COND.20191242-sp) |
| Enumeration Date | 2019-11-14 |
| Last Update Date | 2024-07-01 |