| NPI | 1619185709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA 8330) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: HI SP 942) |
| 235Z00000X Speech-Language Pathologist, (Licence: MA 7069) | |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2007-07-08 |