| NPI | 1790824860 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA 11616) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: FL SA11616) |
| 235Z00000X Speech-Language Pathologist, (Licence: FL HO451A) | |
| 235Z00000X Speech-Language Pathologist, (Licence: NY 010607-1) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2017-08-11 |