| NPI | 1154993525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: LA 9277) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 26909) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2024-07-29 |