| NPI | 1487684296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NE 677) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IA 01124) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2007-07-08 |