| NPI | 1689187619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60952061) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: OR 016483) |
| 235Z00000X Speech-Language Pathologist, (Licence: CA 25755) | |
| 235Z00000X Speech-Language Pathologist, (Licence: MT 6661) | |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2021-12-22 |