| NPI | 1043510019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MO 2011039545) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: PA AT006190) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2023-04-25 |