| NPI | 1518203454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 034060) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 19431) |
| Enumeration Date | 2012-12-21 |
| Last Update Date | 2024-04-16 |