| NPI | 1225861073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: FL 22925) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: CA 36478) |
| Enumeration Date | 2024-08-26 |
| Last Update Date | 2024-08-26 |