NPI | 1972002780 |
---|---|
Former Name | BIANCA BUSTAMANTE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 12007) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 12007) |
Enumeration Date | 2018-02-07 |
Last Update Date | 2021-02-05 |