| NPI | 1982010005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: 14059940) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60675062) |
| 235Z00000X Speech-Language Pathologist, (Licence: WA 531606B) | |
| 235Z00000X Speech-Language Pathologist, (Licence: OR 015323) | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2021-10-13 |