| NPI | 1518162841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OK 4015) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 16450) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2013-04-09 |