| NPI | 1063673978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IL 146.009753) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202005513) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2011-07-21 |