| NPI | 1174918841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA 329) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AK 504) |
| 235Z00000X Speech-Language Pathologist, (Licence: TN SP4088) | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2015-03-31 |