| NPI | 1851597199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: DE O1-0001767) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202004207) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2023-07-03 |