| 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 |