| NPI | 1457321465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: TX 50365) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 11764) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2007-12-05 |