| NPI | 1780134924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 11498) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA 13763) |
| 235Z00000X Speech-Language Pathologist, (Licence: CA 23652) | |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2016-10-12 |