| NPI | 1700942067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 016304) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: NY 1476) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2009-01-13 |