| NPI | 1285185983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CT 004980) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL012968) |
| 235Z00000X Speech-Language Pathologist, (Licence: MA 493161) | |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2016-10-18 |