| NPI | 1861922494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 25785) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CO PSLP00000052) |
| 235Z00000X Speech-Language Pathologist, (Licence: AZ SLP10625) | |
| 235Z00000X Speech-Language Pathologist, (Licence: TX 113160) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2018-03-17 |