| NPI | 1114122504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 58016569) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NJ 41YS425700) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2007-07-08 |