| NPI | 1982774980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA9039) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: GA SLP004973) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2011-01-25 |