| NPI | 1013907567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: ID AUD-1118) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: UT 5341414-4101) |
| 231H00000X Audiologist (Licence: ID HA-1033) | |
| 332S00000X Hearing Aid Equipment | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2017-08-15 |