| NPI | 1386630762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IA 01409) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MN 7574) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2007-07-08 |