| NPI | 1104297449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MI 1601001048) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: VT 145.0116325) |
| 231H00000X Audiologist (Licence: CO AUD.0000941) | |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2024-02-28 |