| NPI | 1124187844 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 231H00000X Audiologist (Licence: FL AY2760)  | 
| Additional Taxonomies | 231H00000X Audiologist (Licence: CA AU1612)  | 
| Enumeration Date | 2006-12-08 | 
| Last Update Date | 2024-01-11 |