| NPI | 1255470993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: MD 00270) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: VA 2202004483) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-07-08 |