| NPI | 1457977993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: LA 4050) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: LA 4050) |
| Enumeration Date | 2020-06-21 |
| Last Update Date | 2020-09-08 |