| NPI | 1346417128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 15061) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WI 2810-154) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2025-01-19 |