| NPI | 1851682462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA11443) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ5227) |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2019-03-14 |