| NPI | 1720249956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: TN A0000001173) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TN SP0000002046) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2020-03-07 |