| NPI | 1801304993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AZ TSLP14044) |
| Additional Taxonomies | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: CA 5914) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2024-07-30 |