| NPI | 1811258395 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MO 117632) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IL 146.005630) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2012-05-31 |