| NPI | 1841449618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: KS 813) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MO 02045) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2022-01-25 |