| NPI | 1639309800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60093354) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 10357) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2024-04-06 |