| NPI | 1659429371 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OH SP5113) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WV SUP0629) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |