| NPI | 1841442977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MD 2202003494) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: VA 04154) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2008-10-21 |