| NPI | 1508169327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Q00000X Developmental Therapist |
| Additional Taxonomies | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: FL SI1128) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2012-03-19 |