| NPI | 1568750610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: PA SL011590) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: DC SLP000455) |
| 235Z00000X Speech-Language Pathologist, (Licence: CA 23919) | |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2018-07-28 |