| NPI | 1922133347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IA 00091) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WI 2317-154) |
| 235Z00000X Speech-Language Pathologist, (Licence: IL 146.006911) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2007-07-09 |