| NPI | 1164814976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 23805) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 9658) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2023-02-13 |