| NPI | 1174981005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CT 002077) |
| Enumeration Date | 2016-02-06 |
| Last Update Date | 2016-02-06 |