| NPI | 1821274994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MD 05823) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 0163421) |
| 235Z00000X Speech-Language Pathologist, (Licence: CA 21469) | |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2016-08-03 |