| NPI | 1508860339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: GA SLP007263) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NC 6545) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2015-10-22 |