| NPI | 1528401551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MA 9044) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 019880) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2015-10-09 |