| NPI | 1700401015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NH 2401) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MA 78583) |
| 235Z00000X Speech-Language Pathologist, (Licence: WV SLP-2091) | |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2023-09-27 |