| NPI | 1154454676 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: KY 142216) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: KY 2115) |
| 235Z00000X Speech-Language Pathologist, (Licence: VA 2202009879) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2021-04-06 |