| NPI | 1174885867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 022591) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 612156121) |
| Enumeration Date | 2012-06-09 |
| Last Update Date | 2013-02-23 |