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 |