| NPI | 1285866723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 7185) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: NC 7209) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2010-10-05 |