| NPI | 1033293386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: GA 005797) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: SC 3264) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-07-09 |