| NPI | 1093157935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60390523) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL011128) |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2013-07-19 |