| NPI | 1073736351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202001573) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NC 3603) |
| 235Z00000X Speech-Language Pathologist, (Licence: FL SA8384) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |