| NPI | 1811538697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: UT 10850140-4102) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: UT 14129836) |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2019-10-03 |