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 |