| NPI | 1790174605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 114527) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY slp10227) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2021-07-27 |