| NPI | 1992130298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: ME SP2360) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: ME ST2283) |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2015-01-12 |