| NPI | 1467076729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 31244) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NV SP-2912) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2026-06-16 |