| NPI | 1780231456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 33528) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: ID 3471249) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2025-03-10 |