| NPI | 1174853261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2355S0801X Specialist/Technologist Speech-Language Assistant (Licence: PR 1144) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PR 1701) |
| Enumeration Date | 2010-01-12 |
| Last Update Date | 2010-01-12 |