| NPI | 1598324816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: GA SLP011161) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 13462) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2021-12-01 |