| NPI | 1386762516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231HA2500X Audiologist, Assistive Technology Supplier (Licence: MO 105448) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MO 105448) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |