| NPI | 1114044302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: PA AT-000665-L) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: OH A-01504) |
| 231H00000X Audiologist (Licence: WV A0048) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-07-08 |