| NPI | 1831747856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NM SLP6995) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MI 7101002900) |
| 235Z00000X Speech-Language Pathologist, (Licence: NV SP-2609) | |
| 235Z00000X Speech-Language Pathologist, (Licence: WY SP-1038) | |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2020-02-13 |