| NPI | 1720418304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 20841) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: SC 4951) |
| 235Z00000X Speech-Language Pathologist, (Licence: OR 015087) | |
| 235Z00000X Speech-Language Pathologist, (Licence: VA 2202007029) | |
| Enumeration Date | 2013-11-19 |
| Last Update Date | 2013-11-19 |