| NPI | 1740662113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WI 4707-154) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA 14114130) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2022-09-21 |