| NPI | 1962702720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: ME SP128) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: ME SP#128) |
| Enumeration Date | 2010-10-27 |
| Last Update Date | 2010-10-27 |