| NPI | 1023053154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: OR 22612) |
| Additional Taxonomies | 237700000X Hearing Instrument Specialist (Licence: OR HAS-P-003469) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2007-07-08 |