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 |