| NPI | 1205152303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 101220) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA2806) |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2010-04-14 |