| NPI | 1780012021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NM SAH-2023-0206) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: ID SLP-2325) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2023-11-17 |