| NPI | 1649402785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: CA 19686) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: NY 017508) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2022-07-21 |