| NPI | 1114281763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 021728) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 106289) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2012-06-28 |