| NPI | 1548577893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AZ Slp6694) |
| Additional Taxonomies | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: AZ #SLPA6694) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2018-04-16 |