| NPI | 1386051951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 011309-1) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IL 146.011892) |
| 235Z00000X Speech-Language Pathologist, (Licence: PA SL011655) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2014-07-16 |