| NPI | 1265629919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 19027) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MO 0348199) |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2013-04-09 |