| NPI | 1710340435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: TX 39446) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: TX 39446) |
| 225XP0200X Occupational Therapist, Pediatrics (Licence: TX 39446) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2024-05-31 |