| NPI | 1730685876 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: ME ST2835) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: ME St2683) |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2023-05-12 |