| NPI | 1699954974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 8666) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: SC 1054) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2010-03-08 |