| NPI | 1043582638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NJ 41YA00037500) |
| Additional Taxonomies | 237700000X Hearing Instrument Specialist (Licence: NJ 25MG00106900) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-01-30 |