| NPI | 1063631893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CT 003863) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NJ 41ys0052300) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2007-07-08 |