| NPI | 1013257393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: PA SL011842) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MO 2013005278) |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2018-12-20 |