| NPI | 1285113886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202006613) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: DC SLP001209) |
| 235Z00000X Speech-Language Pathologist, (Licence: MD 06312) | |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2018-08-14 |