| NPI | 1154648178 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: ME SP1192) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NH 0877) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2010-04-29 |