NPI | 1669874244 |
---|---|
Former Name | JESSICA SAM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 024772-1) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2014-09-25 |
Last Update Date | 2021-02-13 |