| NPI | 1902074305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NY 017170) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 17036) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2026-04-29 |