| NPI | 1225564123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60473221) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: OR 015699) |
| 235Z00000X Speech-Language Pathologist, (Licence: CA SP 24118) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |