| NPI | 1922835362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 39985) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MN 528999) |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2025-08-15 |