| NPI | 1861636789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 010367) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NV 010367) |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2009-04-22 |