| NPI | 1508021148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CO SLP.0003111) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NC 6174) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2021-06-03 |