| NPI | 1538482138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AR SP#3470) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL010236) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2014-04-08 |