| NPI | 1245458983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: NJ 41YS00537500) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: NY 016795) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2007-07-08 |