| NPI | 1194298802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 28872) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 12792) |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2025-02-25 |