| NPI | 1003000340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: MI ASHA01114077) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2007-08-29 |