| NPI | 1790491645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 033498) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2023-09-05 |