| NPI | 1487011003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: KS 3876) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: MO 2015038134) |
| 235Z00000X Speech-Language Pathologist (Licence: AR SP#2911) | |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2016-01-27 |