| NPI | 1780819029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MD 03798) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202003170) |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2009-05-15 |