| NPI | 1861795080 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NJ 41Y500170500) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: RI SP01077) |
| 235Z00000X Speech-Language Pathologist, (Licence: MA 8133) | |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2010-12-09 |