| NPI | 1780036913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: CA 14991) |
| Additional Taxonomies | 2355S0801X Specialist/Technologist Speech-Language Assistant (Licence: CA SPA3851) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2020-09-24 |