| NPI | 1548500879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: OH SP10435) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: MI L2458516) |
| Enumeration Date | 2013-02-23 |
| Last Update Date | 2013-02-23 |