| NPI | 1801010186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TN 0000004021) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: GA SLP006493) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2022-03-21 |