| NPI | 1154387645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NJ 41YB00000200) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: NJ YB00002) |
| 235Z00000X Speech-Language Pathologist, (Licence: NJ YB00002) | |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2019-08-16 |