| NPI | 1093903460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TN 3788) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NC 5886) |
| 235Z00000X Speech-Language Pathologist, (Licence: VA 2202004079) | |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2016-09-28 |