| NPI | 1013194257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WV 32) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WV 59) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2008-01-30 |