| NPI | 1104394790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MD 08834) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202009115) |
| 235Z00000X Speech-Language Pathologist, (Licence: DC SLP001252) | |
| 235Z00000X Speech-Language Pathologist, (Licence: CA 32120) | |
| 235Z00000X Speech-Language Pathologist, (Licence: GA SLP011484) | |
| 235Z00000X Speech-Language Pathologist, (Licence: LA 8990) | |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2024-12-20 |