| NPI | 1023212776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 8637) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC 2301) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2011-04-11 |