| NPI | 1275419160 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202012066) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CT 7790) |
| Enumeration Date | 2025-08-14 |
| Last Update Date | 2025-08-14 |