| NPI | 1285843409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: KY KY-2866) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IN 22004891A) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2012-02-20 |