| NPI | 1003150970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: NM 5419) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: IA 002388) |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2013-10-01 |