| NPI | 1437587391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MN 9615) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WA 60378886) |
| Enumeration Date | 2013-10-30 |
| Last Update Date | 2018-04-04 |