| NPI | 1336282797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: KY 0410) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: KY 0410) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2011-01-19 |