| NPI | 1740826353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WI 4974-154) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 113387) |
| Enumeration Date | 2019-11-19 |
| Last Update Date | 2019-11-19 |