| NPI | 1093079808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NE 305) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: MO 201209713) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2019-07-09 |