| NPI | 1043468101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60153763) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 81863) |
| 235Z00000X Speech-Language Pathologist, (Licence: WA MD60153763) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2021-06-27 |