| NPI | 1396761490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OH SP8377) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL008181) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2007-07-08 |