Russell Clark, AUD Valid NPI

Individual provider · Audiologist · Eagle, ID

NPI

1538692249

Type

Individual (Type 1)

Primary specialty

Audiologist

Specialty group

Speech, Language and Hearing Service Providers

Taxonomy code

231H00000X

License number

AUD-1526 (ID)

Sex

Male

Sole proprietor

No

Enumerated

2017-04-10

Last updated

2018-03-01