| NPI | 1588930192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OR 12744) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: OR 012744) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2018-05-14 |