| NPI | 1114479847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NM 6245) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NM C-6051) |
| Enumeration Date | 2016-10-28 |
| Last Update Date | 2018-04-17 |