| NPI | 1053430397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: OR 20698) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: OR 20698) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2011-08-19 |