| NPI | 1861130593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2022-05-23 |