| NPI | 1215386339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 023999-01) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2024-12-12 |