| NPI | 1609199207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 017126) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA SP 16606) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2010-03-10 |