| NPI | 1356341143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MO 114074) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: KS 1704) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2007-07-08 |