| NPI | 1215443858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 21210) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 12142355) |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2017-12-19 |