| NPI | 1144612854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AZ 4734123) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AZ TSLP9276) |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2015-03-05 |