| NPI | 1750760617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60962862) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 109592) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2019-07-26 |