| NPI | 1669675179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CT 003467) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 014368-1) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2009-02-12 |