| NPI | 1205277597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: LA 648) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: LA 648) |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2024-05-06 |