| NPI | 1821738782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: UT 13944820-4102) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: ID SLP-5337) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-06-30 |