| NPI | 1811200298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 31750) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NV 1122) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2021-11-30 |