| NPI | 1871953661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: DC SLP000864) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 07606) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2016-03-07 |