| NPI | 1407205230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NE 1952) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NE 518) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2017-05-30 |