| NPI | 1871178061 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NJ 41YS01065800) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL014172) |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2021-03-10 |