| NPI | 1073022315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: VA 2201001681) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: MD 01437) |
| 237600000X Audiologist-Hearing Aid Fitter | |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2020-09-11 |