| NPI | 1275710931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: GA AUD003083) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: GA SLP005188) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2008-09-24 |