| NPI | 1114276185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OR 10682) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA SP 19786) |
| 235Z00000X Speech-Language Pathologist, (Licence: WA LL 60132469) | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2012-09-05 |