| NPI | 1700536646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202011857) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: SC 7612) |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2025-04-28 |