| NPI | 1326314410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: GA 006746) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 16975) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2012-03-22 |