| NPI | 1013192525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60892459) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AK 235) |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2023-04-07 |