| NPI | 1992346480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MD 09500) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 01958L) |
| Enumeration Date | 2019-10-05 |
| Last Update Date | 2021-10-28 |