| NPI | 1982150488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AZ SLP10556) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AZ TSLP10556) |
| 235Z00000X Speech-Language Pathologist, (Licence: ND 1530) | |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2020-04-07 |