| NPI | 1225499973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OR 15280) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 18750) |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2016-03-09 |