| NPI | 1063871226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 11612) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AZ SLP8879) |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2016-02-16 |