| NPI | 1043543788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 2288) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: NC 1160) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2009-09-14 |