| NPI | 1902382229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MA 77199-SP-SL) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2019-04-24 |