| 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 |