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 |