| NPI | 1548919962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 031628-01) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MA 78082-SP-SL) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2022-03-22 |