| NPI | 1063626570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: UT 1129549937) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: UT 1129549937) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2007-07-08 |