| NPI | 1932615531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202008513) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: DC SLP001484) |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2021-08-31 |