| NPI | 1639434335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OH sp.9631) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IL 146011021) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2015-02-22 |