| NPI | 1730210899 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MN 8123) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: MN 8123) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2022-09-23 |