| NPI | 1760679104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA sp13467) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: CA AU 3073) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2016-01-19 |