| NPI | 1639334485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 18007) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL009264) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2023-08-29 |