| NPI | 1053045286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MI 1601001138) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: PA AT006838) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2024-11-03 |