| NPI | 1194960609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 1212829) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 019020-1) |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2010-06-23 |