NPI | 1912320219 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202010711) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA 10986) |
Enumeration Date | 2014-01-23 |
Last Update Date | 2024-03-02 |