| NPI | 1164595591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NY 000735) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 000004) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2008-08-05 |