| NPI | 1457650715 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CT 003024) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CT 03-040890) |
| 235Z00000X Speech-Language Pathologist, (Licence: NY 009912-1) | |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2017-01-18 |