| NPI | 1245860584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 029160-01) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IL 146.015120) |
| Enumeration Date | 2020-01-24 |
| Last Update Date | 2020-01-24 |