| NPI | 1528192101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: FL AY 500) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: FL SA 2733) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-09 |