| NPI | 1134732688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA17989) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 105622778) |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2020-08-25 |