| NPI | 1497388581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 13851) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202009409) |
| Enumeration Date | 2020-02-17 |
| Last Update Date | 2020-02-17 |