| NPI | 1770847881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OR 012941) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: UT 8339827-4102) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2020-11-11 |