NPI | 1205123023 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WV SLP-1394) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL006359L) |
Enumeration Date | 2011-06-30 |
Last Update Date | 2012-10-05 |