| NPI | 1891207924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 225A00000X Music Therapist |
| 231H00000X Audiologist | |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2018-01-03 |