| NPI | 1679748396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AZ SLP5096) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AZ 0596) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2024-02-15 |