| NPI | 1356106538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 39583) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AZ SLP15889) |
| Enumeration Date | 2024-02-16 |
| Last Update Date | 2025-08-04 |