| NPI | 1053314930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: TX 51019) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: TX 90553) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: TX 51019) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2014-05-05 |