| NPI | 1346682713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MA SP-9896-SL) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2016-06-02 |