| NPI | 1447635297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 11334) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 07573) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2015-07-22 |