| NPI | 1811545908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 113746) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: 14175516) |
| 235Z00000X Speech-Language Pathologist, (Licence: PA SL014383) | |
| Enumeration Date | 2019-08-31 |
| Last Update Date | 2019-08-31 |