| NPI | 1114152600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: ME AP2652) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: KY 0534) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: KY 1028) | |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2022-07-21 |