| NPI | 1770067316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NJ 41YS00702900) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 022800) |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2022-09-16 |