| NPI | 1679584833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NM SLP2622) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: NM 5702) |
| 235Z00000X Speech-Language Pathologist, (Licence: TX 11247) | |
| 235Z00000X Speech-Language Pathologist, (Licence: NM 2622) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2022-04-20 |