| NPI | 1831300581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 013529) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AZ AZ5057) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2011-01-21 |