| NPI | 1639617400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IL 146.014608) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 024546) |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2019-07-09 |