| NPI | 1497358709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NJ 41YS00390700) |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2020-11-18 |