| NPI | 1710237474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OR 016639) |
| Additional Taxonomies | 235500000X Specialist/Technologist |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2026-02-04 |