| NPI | 1104221357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: KY 100263) |
| Additional Taxonomies | 237700000X Hearing Instrument Specialist (Licence: KY 100537) |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2022-08-01 |