| NPI | 1639179583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MS A2303) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MS S2303) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2007-07-08 |