| NPI | 1710337472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: TX 112449) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 112449) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2024-05-08 |