| NPI | 1902033962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: PR 473) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: FL 15857) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2017-12-05 |