| NPI | 1770769697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AZ SLP13442) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: OH 9863) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2022-01-07 |