| NPI | 1104351964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: GA SLP010930) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 17522) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2020-08-03 |