| NPI | 1699795922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: WI 157) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WI 386) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-08 |