| NPI | 1356421986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: KS 1192) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MO 109419) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2007-07-08 |