| NPI | 1265661243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OR 12024) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WA LL00004701) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2009-07-10 |