| NPI | 1578030086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA SP27939) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA ASHA14095144) |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2024-08-01 |