| NPI | 1730424029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MO 2004016682) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: KY 3531) |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2024-12-30 |