| NPI | 1841609989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MN 9771) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NM C-5562) |
| Enumeration Date | 2014-08-02 |
| Last Update Date | 2021-02-01 |