| NPI | 1215974167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NJ 41YS00672000) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 011677) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2011-09-12 |