| NPI | 1538390968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: IA 001989) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: MN 7840) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2010-11-08 |