| NPI | 1740773217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 116164) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL 16151) |
| 235Z00000X Speech-Language Pathologist, (Licence: CA 28161) | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2026-08-31 |