| NPI | 1750799342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: CO 0000682) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: CA 21491) |
| 235Z00000X Speech-Language Pathologist (Licence: AZ SLP8831) | |
| Enumeration Date | 2014-07-26 |
| Last Update Date | 2014-07-26 |