| NPI | 1902068521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CO 12080162) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IN 22003820A) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2017-05-11 |