| NPI | 1013521160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MN 10104) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 30576) |
| Enumeration Date | 2020-09-05 |
| Last Update Date | 2024-03-03 |