| NPI | 1215693270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: PA SL015454) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 29890) |
| Enumeration Date | 2021-11-15 |
| Last Update Date | 2026-05-18 |