| NPI | 1891242467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA15983) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SZ 7715) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2021-03-12 |