| NPI | 1104332345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202008443) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: LA 6767) |
| 235Z00000X Speech-Language Pathologist, (Licence: DC SLP001095) | |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2017-12-26 |