| NPI | 1407307069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 026538) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NM 6105) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2018-03-17 |