| NPI | 1629931092 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 27377) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL018150) |
| Enumeration Date | 2025-12-03 |
| Last Update Date | 2026-06-19 |