| NPI | 1366645715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: SC 3959) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA9172) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2019-04-17 |