| NPI | 1790108694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CO 0001101) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 108387) |
| 235Z00000X Speech-Language Pathologist, (Licence: LA 6794) | |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2014-01-28 |