| NPI | 1366455800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: TX 51328) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 16702) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2022-08-12 |