| NPI | 1922549922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: PA SL013187) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 08262) |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2018-11-14 |