| NPI | 1205972171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MT 1194) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: ME SP653) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2011-07-19 |