| NPI | 1780102046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MD 08738) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL013605) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2019-11-15 |