| NPI | 1023685104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 15624) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2021-07-23 |