| NPI | 1578842183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 18671) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 104955) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2026-06-04 |