| NPI | 1295025617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OH 0073) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH 0000314) |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2011-04-19 |