| NPI | 1871928929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MO 2014020552) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MO 2013024396) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2016-11-03 |