| NPI | 1346556495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: ME SP2103) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MA 9121) |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2017-09-20 |