| NPI | 1902057300 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MO 2008029382) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: KS 3652) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2017-04-24 |