| NPI | 1366089989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: VA 2202010379) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: CO 0003776) |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2023-08-25 |