| NPI | 1750127817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MN 1019021) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MN 528869) |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2026-04-21 |