| NPI | 1114155769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: UT 9567781-4101) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: TX 80169) |
| 231H00000X Audiologist (Licence: ID AUD-2537) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2016-10-14 |