| NPI | 1346584885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 14061396) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NC 9885) |
| Enumeration Date | 2012-11-21 |
| Last Update Date | 2012-11-21 |