| NPI | 1669764213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 16775) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: GA 006792) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2012-02-28 |