| NPI | 1770119059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2355S0801X Specialist/Technologist Speech-Language Assistant (Licence: MO 2023035485) |
| Additional Taxonomies | 261QH0700X Clinic/Center Hearing and Speech (Licence: TX 41452) |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2025-10-20 |