| NPI | 1821682576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 031875) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-02-23 |
| Last Update Date | 2023-08-30 |