| NPI | 1669774543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TN 4200) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NC 13461) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2019-04-23 |