| NPI | 1649669052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: SC 8071) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 021775) |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2026-03-31 |