| 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 |