| NPI | 1093174120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AZ SLP9792) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MI 7101002366) |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2016-02-17 |