| NPI | 1336418078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: KY 3528) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: OH SP.8435) |
| Enumeration Date | 2011-12-27 |
| Last Update Date | 2011-12-27 |