NPI | 1215107321 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NM C-4144) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM C-4144) |
Enumeration Date | 2008-03-04 |
Last Update Date | 2008-03-04 |