| NPI | 1124261490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL 00003312) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: ID SLP-1788) |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2009-04-15 |