| NPI | 1902466915 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202009486) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL015332) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2024-03-07 |