| NPI | 1811201577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 15910) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NJ 41ys00497900) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2010-08-04 |