| NPI | 1295872539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA9244) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MO 2007001670) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2009-11-20 |