| NPI | 1669627584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IA 002150) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60052242) |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2011-07-19 |