| 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 |