| NPI | 1275852642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IL 146012075) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| 235Z00000X Speech-Language Pathologist, (Licence: MA SP-9083-SL) | |
| 235Z00000X Speech-Language Pathologist, (Licence: NH 1508) | |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2018-12-17 |