| NPI | 1104181072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 014158-1) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CT 004085) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2015-09-03 |