| 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 |