| NPI | 1023172616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA5946) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: FL SA5946) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2015-03-20 |