| NPI | 1720763360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA21535) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AL 4122) |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2023-06-20 |