| NPI | 1114140837 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MI 1601000374) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: MI 1601000374) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2009-12-21 |