| NPI | 1821277039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OR 013095) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WA 60191496) |
| 235Z00000X Speech-Language Pathologist, (Licence: CA 4852) | |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2022-03-16 |