| NPI | 1225410772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MD 01373) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: KY SLPAUD00219027) |
| 231H00000X Audiologist (Licence: OH A.01971) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2016-04-05 |