| NPI | 1952503641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: UT 5005875-4102) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202004997) |
| 235Z00000X Speech-Language Pathologist, (Licence: MD 0517191505) | |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2007-07-08 |