| NPI | 1750436176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MS S2906) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 109926) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2016-04-13 |