| NPI | 1629000435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: SC 816) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: GA 1669) |
| 235Z00000X Speech-Language Pathologist, (Licence: NC 6816) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2013-04-26 |