| NPI | 1003807322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: WI 83156) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: WI 83156) |
| 237700000X Hearing Instrument Specialist (Licence: WI 83156) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2017-01-20 |