| NPI | 1962940296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AZ SLP 8259) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MT SLP-SP-LIC 5490) |
| 235Z00000X Speech-Language Pathologist, (Licence: ID SLP 2986) | |
| 235Z00000X Speech-Language Pathologist, (Licence: CO SLP 2610) | |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-02-07 |