NPI | 1073716817 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 220200357) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: 00870022) |
235Z00000X Speech-Language Pathologist, (Licence: WV SLP-0438) | |
Enumeration Date | 2007-06-08 |
Last Update Date | 2007-07-08 |