| NPI | 1124539259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202005173) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NC 3446) |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2017-10-16 |