| NPI | 1083139497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: UT 11356974-4101) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: MO 2017025273) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2024-09-16 |