NPI | 1689256307 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MT 9656) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MT SLP-LTD-LIC-77) |
Enumeration Date | 2021-04-22 |
Last Update Date | 2022-01-31 |