| NPI | 1609024520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: IA 001898) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2011-05-26 |