| NPI | 1184865263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MO 2010025334) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WA LL 60062948) |
| 235Z00000X Speech-Language Pathologist, (Licence: AK 128) | |
| 235Z00000X Speech-Language Pathologist, (Licence: CA 16453) | |
| Enumeration Date | 2009-03-18 |
| Last Update Date | 2010-09-14 |