| NPI | 1477033652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 029520) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CO SLP.0006890) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2026-08-06 |