| NPI | 1669751012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MI 7101004969) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 107979) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2015-10-12 |