| NPI | 1043627490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: CO 0000732) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: AZ DA8789) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2021-05-27 |