| NPI | 1982070371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 14092792) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2018-03-17 |