| NPI | 1083841977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202005729) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 05276) |
| 235Z00000X Speech-Language Pathologist, (Licence: NH 1037) | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2009-06-17 |