| NPI | 1497158679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MD 05895) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: SC 5396) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2014-10-02 |