| NPI | 1265623896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OR 10850) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WA LL00003546) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2007-08-08 |