| NPI | 1225454796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL00004763) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: ID SLP-2092) |
| Enumeration Date | 2014-03-08 |
| Last Update Date | 2014-03-08 |