| NPI | 1386760858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MD 03163) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202002527) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2007-07-08 |