| NPI | 1780934521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 112367) |
| Additional Taxonomies | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: TX 36978) |
| 235Z00000X Speech-Language Pathologist, (Licence: 14045152) | |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2022-09-01 |