| NPI | 1568770113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: RI slp00145) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL sa11166) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2014-02-19 |