| NPI | 1740729813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OH SP.11126) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL011959) |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2017-02-21 |