| NPI | 1194718205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NY 000898) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 002232) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2012-09-26 |