| NPI | 1891931853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MA 07990) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA SP12053) |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2016-09-25 |