| NPI | 1215953187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA 8609) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: FL SA8609) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2012-05-02 |