| NPI | 1093105686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MD 674374) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 04028) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2015-02-03 |