| NPI | 1528114717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 15962) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 015108) |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2026-04-21 |