| NPI | 1295309979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202012524) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA19040) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2026-06-29 |