| NPI | 1942594460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 021009-1) |
| 363A00000X Physician Assistant (Licence: NY 019529) | |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2023-10-16 |