| NPI | 1316052822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 17530) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TN 0000004920) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2013-04-15 |