| NPI | 1396588612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: NY 1769309232) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 709608) |
| Enumeration Date | 2024-06-14 |
| Last Update Date | 2024-06-14 |