| NPI | 1902227929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WY SP796) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AK slps506) |
| 235Z00000X Speech-Language Pathologist, (Licence: WA SI60396745) | |
| 235Z00000X Speech-Language Pathologist, (Licence: MI 7101005288) | |
| 235Z00000X Speech-Language Pathologist, (Licence: MT SLP-SP-LIC-7381) | |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2019-08-23 |