| NPI | 1104467851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 30310) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 13586) |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2020-09-07 |