| NPI | 1619373305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IL 146.009192) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: DC SLP000607) |
| 235Z00000X Speech-Language Pathologist, (Licence: NM 5241) | |
| 235Z00000X Speech-Language Pathologist, (Licence: CA 18257) | |
| 235Z00000X Speech-Language Pathologist, (Licence: TX 103897) | |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2014-11-07 |