| NPI | 1871239962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AR 202041) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NC 15344) |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2023-01-09 |