NPI | 1669751012 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 107979) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MI 7101004969) |
Enumeration Date | 2011-08-16 |
Last Update Date | 2024-08-08 |