| NPI | 1083226229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CT 006239) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 029583) |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2020-08-19 |