| NPI | 1245965631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202011308) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: LA 7758) |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2024-04-18 |