| NPI | 1801126511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AL 932) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: GA SLP008741) |
| 235Z00000X Speech-Language Pathologist, (Licence: MS S1196) | |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2014-12-02 |