| NPI | 1821419151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MD 07453) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: MD 07453) |
| 314000000X Skilled Nursing Facility (Licence: NJ 41YS00743700) | |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2019-01-07 |