| NPI | 1073163325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: WY A-1051) |
| Additional Taxonomies | 237700000X Hearing Instrument Specialist (Licence: WY 209) |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2020-06-12 |