| NPI | 1063782050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NE 348) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: KS 2200) |
| 231H00000X Audiologist (Licence: KS 1504) | |
| 231H00000X Audiologist (Licence: NE 170) | |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2023-05-03 |