| NPI | 1164493995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: PA SL 000996 L) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA Sl 000996 L) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2007-07-08 |