| NPI | 1851916597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MI 7101006816) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 28343) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2020-06-09 |