| NPI | 1205012465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WI 3033-154) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MA 6276) |
| Enumeration Date | 2008-01-17 |
| Last Update Date | 2008-01-17 |