| NPI | 1689083354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112483) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA12713) |
| 235Z00000X Speech-Language Pathologist, (Licence: AL 3571) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2019-10-22 |