| NPI | 1376051888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 028341) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2022-07-21 |