| NPI | 1114008711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MI 1601000250) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: MI 1601000250) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2013-05-01 |