| NPI | 1568883114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: CA 21306) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: NY 024753) |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2015-07-30 |