| NPI | 1184761736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: UT 108455-4101) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: UT 108455-4102) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2010-04-22 |