| NPI | 1972636967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CT 002958) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: 1202944) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |