| NPI | 1053518183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 2238) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 656463) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2007-07-08 |