| NPI | 1497197016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: MD 07324) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: VA 2202006812) |
| 235Z00000X Speech-Language Pathologist (Licence: WV SLP-1452) | |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2013-07-24 |